• Assesses patient's clinical need against established guidelines to ensure appropriate level of care • Evaluates the necessity, appropriateness and efficiency of medical services and procedures provided • Coordinates and assists in implementation of plan for members • Monitors and coordinates services rendered outside of the network • Advocates for the member/family among various sites to coordinate resource utilization • Documents accurately and comprehensively based on standards of practice • Interacts and communicates with multidisciplinary teams to ensure continuity of care • Evaluates care by problem solving and participating in quality improvement programs • Outreaches to members identified by Horizon as needing Clinical Advocate services • Applies critical thinking and clinical expertise to maximize outcomes while interacting with members and their families